Healthcare Provider Details

I. General information

NPI: 1023949955
Provider Name (Legal Business Name): ASPIRE MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 SE 3RD ST
BEND OR
97702-1754
US

IV. Provider business mailing address

PO BOX 1710
REDMOND OR
97756-0516
US

V. Phone/Fax

Practice location:
  • Phone: 541-516-4099
  • Fax:
Mailing address:
  • Phone: 541-516-4099
  • Fax: 541-516-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WENDY RENGO BOONE
Title or Position: CHIEF FINANCIAL OFFICER
Credential: BOONE
Phone: 541-516-4099